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The Effectiveness of Cognitive Behavioral Therapy and Substance Abuse

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Drug dependent clients are among the most difficult in administering psychological interventions. The drug is the vehicle of escapism from other underlying problems that the client may have. The social and emotional issues can range from anger and depression to many different other social disorders. Based on recent statistics drug use disorders represent a high usage of the population which presents adverse effects and issues for the public and mental health. One of the popular treatment therapies for drug addiction is Cognitive Behavioral Therapy (CBT) which focuses on an individual's beliefs. According to Mc Mullin (2000), "the distinguishing feature of cognitive therapy is its concentration on the client's beliefs, attitudes, and cognitions" (pg. 7).

CBT incorporates the two major types of learning that have been identified in early behavioral theory. One is learning by connotation and the other is learning by consequences. In learning by association or connotation, stimuli that are normally neutral can then trigger substance use, which can result in an association between the stimulus event and substance use. Stimulus triggers can be environmental (people, places, or things), or they may be internal events like thoughts, or emotions. The associations between these occurrences and substance use can develop if they repeatedly occur in close immediacy to one another. Associations are gradually strengthened during the course of repeated occurrences, the substance user becomes subject to cravings that can be stimulated by a growing array of stimuli that were previously neutral but have now become potential triggers.

In learning by consequences substance use behaviors are strengthened by consequences after their use. For example, if after using a substance a person feels more comfortable socially, then, the act of using the substance most likely will be more recurrent in the future. In this case the substance was positively reinforced. If substance use reduces anxiety, tension, stress, or depression, again the likelihood of future use is increased. Although there are negative consequences associated with substance use like health risks, or limitations in everyday functioning the results of the negative reinforcement take longer to present and are not as immediate as the positive reinforcement that is initially given.

There are currently four widely used cognitive behavioral interventions that are used with substance abuse. Relapse prevention therapy tries to target and identify past and present triggers in the client's environment which are then used with skills training to avoid future high risk situations. Contingency management either reinforces or punishes consequences of behavior. Motivational interviewing identifies a person's goals to see if the substance use conflicts with these goals. Finally, behavioral couple's therapy teaches partners to challenge each other and negotiate for change in the behavior of substance use.

One of the aforementioned correlations of emotions linked to substance abuse is depression. In relation to this case study I will mention some overlapping treatment modalities that are commonly used in reference to substance abuse. According to Young (2008), "depressed patients consistently distort their interpretations of events, so they can maintain negative views of themselves, the environment, and their future" (p. 260). In treating substance abuse most cognitive behavioral treatments deal with a one singular theme and that is finding the client's core beliefs which promulgate the issue. An example of a person's core belief that could contribute to substance abuse is their self-concept of themselves. Mc Mullin states (2000), "the value clients have assigned to themselves can have huge staying power, and can last throughout their lives unless they actively do something to change it" (p.48). The combination of a client's low self-concept as a core belief and positive reinforcement of a substance can contribute to continued or recurrent substance abuse.

According to Higgins (2008):

Treatment is designed to assist in the reorganizing the physical and social environments of the user. The goal is to weaken systematically the influence of reinforcement derived from drug use and the related drug-using lifestyle, and to increase the frequency of reinforcement derived from healthier alternative activities, especially those that are incompatible with continued drug use (p.554).

Current Research:

The recent information on cognitive behavioral treatment therapies suggests that it is still the most effective treatment for substance abuse.

Hides reports (2010):

A recent meta-analysis of 34 cognitive-behavioral treatment trials for illicit substance use disorders found CBT had significantly better outcomes (31% abstinent) compared with control conditions (13%), with an aggregate moderate effect size of 0.45 at post-treatment.

Cognitive behavioral therapy treatments are among the most frequently evaluated psychosocial approaches for the treatment of substance use disorders and have a comparatively strong level of empirical support. I will discuss some recent information on the four treatment interventions within cognitive behavioral therapy that are currently used with substance abuse. The information will focus on relapse prevention, contingency management / community reinforcement approach, motivational interviewing, and behavioral couple therapy. I believe in terms of the case study these all can apply for treatment.

Relapse prevention (RP) is mostly used for alcohol abuse but can be used for all types of substance abuse. Coping skills are one of the important techniques that may be taught in relapse prevention. A recent strategy being used more often in coping skills that is brought to the attention of clients is called mindfulness. The definition of being mindful means to develop awareness, but to do so in an open-minded fashion. Mindfulness skills help the client to become more aware and accepting of triggers they may encounter when faced with relapse. As clients become conscious of a trigger it helps them gain a degree of control in their reaction, managing their lives better to avoid relapse.

According to Crane (2009):

Mindful Based Cognitive Therapy (MBCT) was developed as a targeted approach for people who have a history of depression and therefore vulnerable to future episodes. Taught while participants are in remission it aims to enable them to learn how to bring awareness to the body sensations, thoughts, and emotions and to respond adaptively to the early warning



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